I am so excited because I finally (!) got my advanced practice approval in physical agent modalities! It took 2 years for me to take the classes and get the hours. And it took another 3 months for the State Board of OT to approve it. Thank goodness! Now, I don’t need supervision for using ice, heat, laser, ultrasound, iontophoresis or electrical stimulation on my pts! Woo hoo!

Now, to take the class for advanced practice hands. Yay!

Bleh. Apparently, I work in an abdominal surgery factory. These pts are pretty high level, but have a lot of pain associated with moving around in bed or just trying to move around . I don’t know what is causing this rash of abdominal surgeries. It’s like we have 5 of these pts a week! A few of them had severe cases of diverticulitis, others some type of cancer such as adenocarcinoma, pancreatic cancer or rectal cancer or other just bizarre incidents.

One of my co-workers said, “I’m so sick of butts and guts!” That’s where the title came from. These pts typically have drains, catheters, IVs, abdominal binders, they might have rectal tubes, epidurals. They move pretty well except that there is a tremendous amount of pain when bending the legs up, rolling or sitting up. As an OT, it’s important to show them how to get in and out of bed with log rolling technique, teaching lower body dressing compensation techniques either with the reacher or different range of motion, early mobilization and toileting transfers.  These things might not sound fun but are very important before discharging home.

A student volunteer told me today:

S: “Well, I don’t want to be a PT, because I don’t think I can handle being a doctor.”

M: “What do you mean?”

S: “Well, I don’t think I’m ready to do all that studying to have a doctorate.”

Time passes throughout the day and I encourage her to ask more questions.

S:”Well, maybe I will just get my Master’s in OT and work for a little while and then when I feel ready, I will get my doctorate in PT.”

I’m sorry…but I had to restrain myself. This is the stupidest thing I have ever heard. I explained to the student that it would be redundant to go to PT school after going to OT school, because you do learn many similar things in PT and OT school. Plus, why would you want to be both? You don’t get paid more money if you have both certifications. You can only work as either PT or OT because you will be reimbursed only providing one service, not both simultaneously. Plus, that’s two certifications to pay for and renew every 2 years. I just couldn’t understand her thought process. The doctorate for PT school is an ENTRY LEVEL doctorate. The Master’s from OT school is an ENTRY LEVEL masters. This is not like getting a PhD or a medical degree! The DPT requires more research during the coursework, that’s why it’s an entry level doctorate. It is no way the same as a PhD or an MD degree. The DPT is similar to the PharmD. It is the minimum requirement for that field. You can’t be a pharmacist without the PharmD, similar to how you cannot be a PT without the DPT starting in 2014. It’s called degree creep and it’s how universities get more money, while saying they are advancing their profession. The sad part about it is that you could be an RN, with only an associates degree and get paid as much as a DPT or an MOT. Therapists as a whole, get paid much less (compared to other healthcare professionals) when you consider our schooling and our level of expertise. Radiation techs get paid almost six figures for just an associates degree, but then you have to be exposed to radiation every day.

I’ve been talking with several undergrad students. And they are kind of driving me nuts. I LOVE the occupational therapy profession. I am grateful that I was able to work for a few years before Healthcare Reform became a hot topic and was looming over our heads. That means that I was able to see a 6-8 pts a day and give them what I consider great quality care. Now, with healthcare reform, be it Obamacare or Romneycare, the American govt is much more calculating with its medical and healthcare reimbursements. We are now being asked to see 10-12 pts in an 8-hour workday. This is because we are now being paid by volume, not by time spent with the pt. Home health therapy was a big money maker, but maybe not so much anymore.  A colleague informed me that as a home health PT or OT, you could make $80/pt. If you see 5 pts x $80= $400. And you don’t even need to spend quality time with them. The pt just needs to sign the paper. You could have spent 60 minutes or 6 minutes with the pt, you still get $80. Or if the pt wasn’t home for therapy, you still get paid. When you hear stories like this…no wonder our country is running in the red! There is fraud, waste and abuse all over the place! These people who were trying to get rich by not doing any work, have messed it up for the rest of us!

Anyway, the original reason I was going to post was that I am getting annoyed by the number of people who tell me that they are applying to OT school because they don’t think they can get into PT school. News Flash: it’s hard getting into any healthcare profession school. PT, OT, SLP, radiation therapy, respiratory therapy, physician assistant, nursing, the list goes on. The fact that people think getting into OT school is easier than PT school perpetuates the myth that OT is a lesser therapy. That drives me nuts! Just ask the stroke pt who can walk around just fine but has no use of his Left arm.  He is walking around, not bumping into things, but he can’t brush his teeth on his own or can’t even eat a hamburger  because he doesn’t have both hands to hold the fat, juicy gourmet burger he wants! Or the beautiful old lady who just wants to be able to put her jewelry on, but can’t because she has lost sensation, strength and dexterity in her fingers. Or the kid who was in a bad car accident that his abdominal wall became necrosed, had to to have surgery and can walk around his hospital room, but can’t put on underwear or get on/off the toilet because he doesn’t know how to move s/p abdominal surgery.  Seriously, OT is very important because it’s very functional, it’s client centered and it’s holistic.

If you want to just treat one part of a person, be a PT. If you want to give client centered, holistic, functional therapy, be an OT.

My first OT student just finished her fieldwork with me. Fieldwork is a 12 week internship, in which the student is essentially an occupational therapist, with supervision of course. Fieldwork is where you do the bulk of your learning. Yes, you learn the foundations and theory in school, but if you are like me, you learn better by doing. This is real life experience. I thoroughly enjoyed my fieldwork. However, I realize now that I did not get very good training in my fieldwork. I worked at the VA, doing acute care and outpatient hands. I really focused on hands, which was great and so challenging for me. I saw traumatic brain injuries as well, which was very interesting. Meeting young, new veterans who sustained concussions because they were in roadside explosions or got hit with IEDs….that was an amazing experience.  I also worked in senior behavioral health. I LOVE demented, depressed and delusional seniors! That was my most favorite experience because it did not feel like work. I love the brain, I love psychology, I love geriatrics and I love activities. It was such a good fit. However, these trainings were not great in learning acute care equipment like ventilators, ICP, dialysis, craniotomies, etc. (See http://otrocks.com/2012/the-little-things/)

I work in a very diverse setting now. I work in acute care. I see brain tumors, joint replacements, leukemia/lymphoma, cancer surgery, strokes, heart problems.When I work outpatient, I see hand injuries, Parkinson’s, Lou Gehrig’s disease, strokes. I love the diversity. It keeps my on my toes and I love all my patients. All my patients bring something special into my life.

My student only did inpatient. She did a pretty good job. She acclimated to the routine well and the acuity of the patients. But the thing that got my goat was….I didn’t even get a thank you card. And before I finished giving her her final evaluation, she asked if I could provide her with a letter of recommendation in the future. Am I getting older? Is this some new thing now? I remember that for every fieldwork I ever did, I always gave my supervisor a handwritten card, expressing my appreciation for their knowledge, expertise and patience in teaching me new things. I remember my professors impressing this upon us prior to the start of our fieldwork. The fieldwork can essentially be a job interview. During your fieldwork, you are acting as the student occupational therapist. You are trained in the system of the department and learn the work dynamics. It is a great time to get your feet wet and network with people. If you like the fieldwork, you might want to get hired there someday! It would seem that you would want to make the best impression throughout the whole fieldwork, from start to finish.

So, when I didn’t get a thank you card or even a verbal thank you…I was miffed. And a brief Google search for “business etiquette” and “thank you cards,” was not very productive. Has the world gone mad? Don’t people value those simple two words anymore?

I do, and I know my supervisor does. When she was interviewing for the open OT position, she made a point of letting us know which applicants thanked her for her time. I think you would be shooting yourself in the foot if you didn’t thank people during these opportunities: job interviews, fieldwork, giving/receiving information during learning. It just doesn’t make sense. And in the setting where I work, which is inter- and multi-disciplinary….not having good business etiquette will not get you far.

If anything, writing a thank you card is another way to be memorable. People have your name written down, they can remember more easily how they know you and in what context. I can only thing of good things that can happen from writing a thank you card. For example, at work, we have a lot of volunteers trying to get hours for admission to either PT or OT school. Volunteers who finish their hours and don’t write a thank you card or let us know they are leaving/done….how would we know or remember them? There are 10 volunteers a week. And then they expect a therapist to write a letter of recommendation for therapy school? Good luck, buddy. You better have been a really outstanding volunteer or at least written a thank you card.

Okay, I’m done blowing off steam now.

We’re back to one of those spells where all the patients are unmotivated, really sick and it’s hard to get jazzed about working. Bleh.

Our poor, new OT. She’s used to people getting better. A third of our patients are going home with hospice or dying in the hospital. It’s taking a little bit of time for her to adjust to this new population. I’m telling you, this is not for the emotionally vulnerable.

And my student! She’s had so many patients with brain tumors. She’s having a hard time seeing them go home with hospice or die. It’s depressing her a bit, but that’s how life in our hospital is. As the OT, you have to think of what is client-centered and what you can do to improve quality of life. Calming, self feeding, exercise, cognitive activities, anything.

I am very proud to announce that OT Rocks! has it’s first guest post!

Isaac is a respiratory therapist, and a very cool cat. The following is his post- showing just how important and amazing respiratory therapy is.

The cool thing about having an in-demand job, is that I can work anywhere I want to. Home care, school based, pediatric, hospital, skilled nursing, outpatient. This is not like everyone else out there looking for a business type of job, 300 applicants for 3 openings. I have a set of skills that gets paid big money by health insurance companies. As you might know, the general population is aging. There are baby boomers out there starting retirement. People of this age are having elective joint replacement surgeries, or sick people are living longer lives thanks to modern medicine.  I also have, what I consider, a huge amount of student loans from OT school. I get paid decent money at my full time job. It helps that I’m married, because my husband and I share expenses. But my student loan! It is so large! How will I ever pay it down? I am on a 10-year payment plan, for one thing. But also, I got a per diem job. I work this job on the weekends. Only when I feel like it, only when I have time. It is in a skilled nursing facility or SNF. It’s also called a SNF because, if you take a sniff when you first walk in…well, you get the idea. You judge a book by its cover, in this case. But the SNF I work in is fancy! It is the fanciest and most expensive nursing home in my area. It has gold trim. Right when you walk in, there is a concierge desk. There is complimentary coffee and pastries. This SNF has a pastry and dessert chef on staff! This SNF has afternoon tea, it is right next to a mall, it has a lot of affluent residents.

I get paid $50/hour to do occupational therapy with these people. This is definitely not how much I get paid doing my full time job. I typically work 7 hours x $50= $350 for one day out of my weekend. It’s nice to have that drop into my bank account. However, I think I am spoiled by academic medicine and working in a large hospital. I don’t think I could ever be happy working full time, 40+ hours/week in a SNF. There is too much pressure to be productive. There is so much paperwork. The whole facility is Medicare driven. There are so many rules for therapy. Every MINUTE is accounted for. The clientele can be fussy or unmotivated. As an occupational therapist, I am one of the most educated people on staff! In most nursing homes, the nurse assistants have a certificate. Most SNFs do not have full time RNs, or if they do, there is only one RN per shift for the whole building. Currently, to be an LVN, you just need a certificate training program. Maybe an LVN has an Associate’s degrees. RNs can either have Associate’s, Bachelor’s or Master’s, but you can bet that most Master’s level nurses will not want to work in a SNF unless they are the managers/directors. The MDs who are responsible for caring for the pts.. I never see them on the weekend. I don’t know if they come by during the weekdays. So when you think that the therapy staff, is the most educated and consistent staff for the facility…it blows my mind. I am used to being around MDs, NPs, PAs, Master’s level RNs, PharmDs. On the other hand, you can be more creative in the SNF setting. There are actual, home-like bathrooms, to practice grooming and hygiene ADL. There is a stove to practice cooking (cooking is a big OT intervention/assessment tool). There are arts and crafts. You can take the pts outside or to the mall for community integration. There is better exercise equipment than in an acute care hospital.

I think there is quite a large number of OTs that work in SNF setting. Most of my OT cohort work in SNFs. They get paid more money than I do, since I work in an acute care hospital. But for me, I like academic medicine. I love being there post-op day #1 after a brain tumor surgery. I love being there from the beginning and getting people started on their therapy journey. I like talking to people who are as educated as me (sounds awful, but true). I like all the learning opportunities I get at work. But if I worked in a SNF, they might be able to pay for my American Occupational Therapy Association membership, pay more money for continuing ed classes. I know that every other Friday, the staff gets free lunch at the SNF. I wouldn’t have to pay for parking if I worked at the SNF.  Both settings have their ups and downs. You have to pick what’s right for you.

I have been working in both inpatient (IP) and outpatient (OP) lately. What I like about inpatient is that the schedule is more flexible. If I get through all my pts, I can have down time to check my email, do work projects, clean or go hunting for items from the rehab dept that have mysteriously disappeared.  I see pts in their most acute state. I get to see someone the day he had a stroke, the day after she had brain surgery, the day after a hip surgery. I converse with other healthcare professionals (RNs, MDs, RTs, CNAs, NPs, PAs) on a regular basis to talk about discharge plans or pt status. I don’t like how physically demanding it is. It can hurt my back, if I have a really hefty or anxious pt. But on the other hand, it could be really easy, if I have pts who can move around well. I don’t like how boring it can get. It can be pretty monotonous some times, seeing joint replacements, back surgeries and brain tumors, cancer. It just gets to be the same old thing, at least to me. Another thing is that the pts are barely wearing any clothes. They might poop, vomit or faint on you. Or the pt may not be available because the pt is having an echocardiogram, cardioversion, PEG tube placement, wound vac placement, anything.

In outpatient therapy, the pts come to you. You don’t expect them to vomit on you, so you can wear nicer clothes. It can be monotonous….carpal tunnel, tennis elbow, forearm pain. Or it can be really challenging….Parkinson’s disease, hemiplegia, oculomotor difficulties, post-op hand pts. It just depends. As the occupational therapist, I set the treatment plan and I choose the interventions. You could argue that therapy is only as boring as you make it.  I don’t like the ergonomics of outpatient. My upper traps  always seem to tense up and then I am in pain…in need of therapy myself. The scheduling is terrible. I have pts back to back, without time for a bathroom break. On the other hand, outpatient therapy lends itself to specializations. There are tons of specializations/certifications that would serve you well in outpatient, if you were interested. Certified lymphedema therapist, certified hand therapist, vision rehab therapist, driving rehab, assistive technology practitioner, the list goes on.

Someone asked me if I like inpatient or outpatient better. They both have their ups/downs. I do like the variety of doing both. I don’t have a favorite because I think either IP or OP, my mantra still applies:  You need to take care of yourself, because no one will take care of you. The patients don’t care if you are sick. All they want is for you to take care of them. This goes with having good time management (because you want to do your documentation and get out of work when there is still light out), setting limits (if you have to pee, you better do it), and realizing that as the therapist, you are in control of the interventions and tx plan. Don’t have boring therapy if you don’t want boring therapy. And always, take care of yourself!

So for now, I can’t decide if I like IP or OP more. I’ll just stay flexible and keep my options open.

Something I have noticed with my student is that I forget all the things I know as an OT.  I just feel like some things are common sense, “duh!” type of things. However, my student has never worked in a hospital before. She doesn’t know what a Foley catheter is, or what telemetry, A-line, cordis, IJ catheter, chest tube, JP drain, ICP, TLSO, cardiac chair, venodynes, nasal cannula, CPAP, sprinting or I&D are. Even though she is in OT school, she might not know what sternal precautions are, or what spine, hip, or abdominal precautions the pts must follow. She might not know about contact precaution rooms. She doesn’t know that working in an acute care hospital, there are A LOT of rules. Rules that you must follow.

If I just systematically go through my day (which I know all you pre-OT/PT students will like) this is what I do:

7:30 AM- At work. Check the number of evaluations that need to be completed that day. Count the number of pts already on OT service. Prioritize and assign pts to therapists depending on diagnosis and need for therapy. Joint replacements, spine and neuro (stroke, brain tumor, brain injury) pts are going to be top priority. 

7:45 AM- Talk with PTs and other OTs re: pt status of all pts receiving therapy.

8 AM- Up on the floor. Going to see my first pt. Must do a chart review on every pt to see what new things are going on: discharge plan, change in mental or medical status, if the pt will go for tests that day, chemo, etc. Because this is acute care, you must always check with the nurse. What if the pt has orthostatic hypotension? I don’t want the pt to faint on me. What if the pt’s platelet count is low and if the pt falls, the pt might bleed to death? Scary things that you need to think about.

From 8-12, I try to pack in as many pts as I can. I must remember to wash my hands or use the alcohol gel before and after I see each pt. Asides from being good hygiene and illness prevention, that is a mandated rule by The Joint Commission on hospital accreditation. If a pt is on oxygen, I need to find a portable O2 tank before we walk around. If the pt is on telemetry (measuring heart waves, beat, respiratory rate), I need to put the pt on a portable monitor if we leave the bedside.  If the pt is dependent for mobility, I need to find help before I try to move the pt  (I don’t want to hurt myself). Does the pt have non-skid socks on (hospital policy)? Does the pt have diarrhea? If so, I better get an adult diaper and put it on the pt. Before all of this, is the pt even mentally with it to follow directions and be safe out of bed?

12-1PM- LUNCH.  I need to eat because I just burned a ton of calories walking all over the hospital and helping move pts around.

1-4PM- See more pts. Sanitize my walker after every pt use. I need to document on every pt (this is an insurance/legal thing), preferably as soon as I am done with each treatment so that I don’t have paperwork piled up at the end of the day. Touch base with other healthcare providers of my pts, so we are all on the same page re: discharge plan, treatment plan in the hospital, etc.

4PM- Go home.

Yay, my day is done and now I can have “me” time. Time to eat and exercise, so I can keep myself healthy so I can do the routine all over again.